The Department of Health and Human Services wants to reduce maternal mortality by 50% by 2025 as part of a sweeping action plan in response to the dire rate of maternal deaths in the U.S.
“Why focus on maternal health in the midst of a pandemic?” U.S. Surgeon General Jerome Adams said during a press conference Thursday morning. “Well, my answer is clear: Without attention and action, maternal health could actually worsen because of this pandemic. We must act now. Our nation and our mothers deserve better.”
About 700 women die each year as a result of a pregnancy-related complication and more than 25,000 suffer issues that could lead to short- or long-term consequences, the department says. The federal action plan comes at a time when pregnant women also face increased risk of severe illness from COVID-19, according to a report from the Centers for Disease Control and Prevention.
In addition to reducing pregnancy-related deaths, the plan announced Thursday also aims to reduce low-risk cesarean deliveries by 25% and achieve blood pressure control in 80% of women of reproductive age with high blood pressure. It accompanies a Surgeon General’s Call to Action that outlines a list of strategies doctors, pregnant women, states, health systems and local communities can take to prevent deaths and complications tied to pregnancy.
“A woman dies every 12 hours in this country from pregnancy-related complications,” Adams said.”This is not just unacceptable. It is something that we need to understand is not inevitable. In fact, the CDC tells us two-thirds of these deaths are preventable.”
Adams also made the point to acknowledge that women of color, particularly Black women, face higher rates of death related to childbirth. According to a Kaiser Family Foundation report, pregnancy-related mortality rates are more than three and two times higher, respectively, for Black and American Indian or Alaska Native women than for white women.
Adams said this heightened risk for Black women occurs regardless of education, status or income.
“One of my officers, Shalon Irving, a Ph.D.-educated epidemiologist, died not long ago from pregnancy-related complications,” he said. Irving died from complications related to high blood pressure shortly after giving birth in 2017. Adams also pointed to singer Beyoncé and athlete Serena Williams, both prominent Black women who have spoken out about their dangerous health experiences giving birth.
HHS on Thursday also announced it is entering into a partnership with nonprofit maternal health group March of Dimes to tackle the maternal health disparity for Black women. The partnership will work on implementing “evidence-based best practices to improve health care in hospital settings,” the agency said.
The action plan’s focus on curbing high blood pressure comes as the CDC says stroke and heart disease caused a third of pregnancy-related deaths from 2011-2015.
Kim Smith, chair of the nonprofit Preeclampsia Foundation’s board of directors, said during Thursday’s briefing that she faced severe high blood pressure that developed into preeclampsia during her first pregnancy in 2012. Her unborn daughter, Kelly, later died.
“What do you do in that moment, as a future mother, as a wife, as someone who has a strong faith, trying to understand why you went from a healthy moment to, within a few hours, preparing to deliver a stillborn child at five and a half months pregnant?” she asked.
The HHS action plan specifically aims to expand the adoption of clinical best practices in maternal health, as well as improve access to quality prenatal care for at-risk populations.
It also aims to improve the quality of postpartum care, particularly by supporting extended Medicaid coverage for substance use services – a practice in line with past HHS budget proposals that have included support for state policies to extend Medicaid coverage up to one year postpartum only for low-income women with substance use disorders.
“The Department will also pursue strategies to close coverage and care gaps for all postpartum women after pregnancy-related Medicaid coverage expires,” the plan states.
The House in September passed a bill allowing states to extend postpartum Medicaid coverage to one year for all low-income pregnant women. Medicaid typically only covers about the first 2 months after giving birth for women eligible during their pregnancy.
“We need to understand that about a third of the deaths that occurred related to pregnancy happen after a woman has left the hospital, up to a year after birth,” he said.
The HHS plan also says it aims to enhance maternal health surveillance by improving data collection and stratifying it by risk factors. Congress in 2018 authorized five-year funding for state review boards to collect maternal mortality and morbidity data.